This video is the second in a three-part series to help oxygen therapy patients better understand the ins/outs of oxygen therapy and Medicare. Today’s session is called: Changing Your Oxygen Solution or Provider.
Changing Your Oxygen Provider Video
Facts About Changing Your Medicare Oxygen Solution
The most common issue we hear about with our customers is that they don’t like their current oxygen therapy solution or provider. This can happen for many reasons but the most common reasons are the following:
I am on oxygen 24 hours per day and my provider has given me tanks and they don’t work with my lifestyle. What are my options ?
My provider gives me terrible support and I want to figure out a different solution. Can you help ?
Recall that Medicare coverage is via a long term rental contract. You may not know it but when you were put on oxygen, you signed a “contract” with your provider. In that contact, the provider is required to provide you with functional equipment that meets your medical needs. In return, Medicare (as your insurance) will pay that provider a monthly rental fee. Your provider may have also pointed out that at the bottom of the contract, it is required to say essentially “a patient can terminate this agreement at any time.”
Here is where it can get a little confusing. As part of an effort to better manage heath care costs, the government designed the supplemental oxygen program such that the contract you signed requires the provider to take care of a patient for 5 years. The cost management portion is that while the provider is required to take care of you, they are only paid for 3 years. I know you’re probably thinking … why is this important to me ?
This is important to you because while you CAN leave a provider anytime you chose, another provider is NEVER required to pick you up. In fact, the program is designed to dis-incentive switching providers because if you leave one provider and go to a second provider, the second provider will be required to take care of you for the remainder of the five year contract but only get paid for what is remaining on the initial 3 year pay-out contract. Because portable oxy concentrators are expensive, it is NEVER going to be a good business decision for a provider to pick up a patient from a different contract and provide them with a portable concentrator. This is the reason that many patients are frustrated as they try to find a medicare provider who will provide them with a portable oxygen concentrator.
So, what are my REAL options if I want a different solution or provider ?
You should always start by asking your current provider for the solution you want - in this example we are discussing, a portable oxygen concentrator. If any Medicare provider is going to help you, they will most likely provide you oxygen tanks unless you ask for a concentrator before signing any contracts.
Once your own provider has told you NO, you can call other Medicare providers to see if they will pick you up but because of the way re-imbursement works, we have never heard of a patient under an existing contract being picked up and provided a portable oxygen concentrator by another provider. With that said, the chances are slim.
The next option to consider is waiting until the end of your contract and then try to see if you can find a provider that has the equipment you desire. It is our understanding some Medicare providers will
provide patients with the full 3 year payout available with portable oxygen concentrators (or other specific equipment you desire).
Our recommended option and the one we have built our business on is for you to find the equipment that meets your medical needs AND gives you the life-style you want and purchase it outright. At the Oxygen Concentrator Store we do not take Medicare, but we do provide patients with a curated selection of the best equipment on the market and superior service. While we only accept payment in cash or credit cards, some supplemental insurance plans (not Medicare or Medicaid) will provide reimbursement and we will help you with that paperwork.
To recap the video:
Because of the way Medicare re-imbursement is designed, why technically possible, it is difficult to switch providers to get a different solution (or service level).
If you want to change your solution, your first step is to talk to your current provider.
The most common method of getting the solution YOU want it to purchase the unit out-right. We will be happy to help understand your medical needs and life style to find the right solution for you.
We hope this helps provide you with a few clear facts on Medicare and supplemental oxygen coverage. There are two additional videos on Medicare coverage.If you still have questions on Medicare coverage, please feel free to call us and let the Oxygen expert you are working with know that you would like to speak with our Insurance Expert and we’ll be happy to try to answer your questions.
Medicare Video #1: Does Medicare Pay for an Oxygen Concentrator?
Medicare Video #3: Supplement Oxygen and Medicare FAQs